Tuesday, February 7, 2023
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Obesity is stalking poor countries, where hunger once reigned

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Y ou might not notice it from the way that inflation, conflict and pandemic have driven up the cost of food in recent years, but the specter of hunger that has haunted humanity for millennia is moving closer to being vanquished.

In middle-income countries, the number of people undernourished fell by roughly a quarter, or 162 million, between 2006 and 2020. That’s more than enough to offset the 43 million increase in low-income nations, which are mostly in sub-Saharan Africa.

In China, home to most of history’s biggest famines, the prevalence of childhood stunting — a typical indicator of malnutrition — is now at levels comparable to the U.S. The shift in India has been just as dramatic. In 2006, more than a third of women were underweight. By 2019, that figure had been cut almost in half.

There’s a worrying trend happening in the background of those figures, however. The share of Indian women who were overweight also nearly doubled, to the extent that it now affects more people than undernourishment:

The picture is the same among men. In the middle-income countries where three-quarters of humanity live, the scourge of undernourishment is being replaced by a fast-rising epidemic of obesity, along with all the attendant problems of diabetes, heart disease and high blood pressure.

The world has yet to reckon with this emerging problem. In tackling hunger, there’s a global infrastructure that’s been in place in one form or another since World War I, when Herbert Hoover set up a mass food drive for occupied Belgium. The main successor to that relief effort, the World Food Programme, delivered 4.2 million metric tons of food in 2020. We have nothing comparable in place to deal with the coming epidemic.

Alleviating hunger in poor countries is paid for in part via rural subsidies in rich nations. The U.S. Farm Bills and European Union’s Common Agricultural Policy deliver income to farmers and generate food surpluses that are exported to the most needy places. Tackling the effects of a rising overweight and obese population in the developing world, however, will fall squarely on the shoulders of the countries where it occurs.

The success of the world in preventing hunger is often seen as a repudiation of the 19th century economist Thomas Malthus, who argued that mass starvation would inevitably result from populations growing faster than agricultural output. In fact, the rising tide of obesity is evidence that the hard limits to food production Malthus envisaged are more binding than many of us suspect.

To the extent that developing countries have managed to capture extra nutrition to feed their populations over the past few decades, an outsize share has come from the lowest-cost calories — fats, sugars and cereal products. The energy in dark green leafy vegetables costs about 29 times more than in fats and oils, while the calories in vitamin A-rich vegetables such as pumpkin or mangoes cost about 10 times their equivalent in sugar:

Many of the countries where saturated fats make up the largest share of energy intake are not the wealthy ones, but poorer nations in southeast Asia, sub-Saharan Africa, and small islands. What’s happening, in both poor and rich countries, is that people are seeking out the lowest-cost calories to add to their diets. Those don’t tend to be the ones that make up a balanced diet — but they’re the ones that a finite world is most capable of supplying.

The effects are most visible in the rise of diabetes. Bangladesh, Egypt, Mexico and Pakistan have already overtaken the U.S. in prevalence of the condition. Its causes still aren’t perfectly understood, but the transition to a more sedentary, calorie-rich lifestyle, especially for people whose mothers suffered gestational diabetes while pregnant, is a key risk factor, according to Paul Zimmet, a professor of diabetes at Monash University in Melbourne.

The world is undergoing a similar transition to what he witnessed in the early 1970s, when he worked in the Pacific island of Nauru, at the time briefly one of the world’s richest countries due to a boom in exports of phosphate fertilizer.

“There was sudden wealth that pitched them into a situation where there was buckets of food, but not much in the way of sports facilities,” he said. Zimmet was flown in on the President’s private jet to carry out tests, and after a day it was clear that between 20% and 30% of the population had diabetes. “The money they had was invested in food and cars. People were going out of supermarkets with trolleys laden with rice and corned beef.”

As in the case of Nauru, the growth of diabetes around the world is a perverse sort of success story. If you’re undernourished in adulthood, your odds of developing type 2 diabetes are far lower. If we’re facing an epidemic of diabetes now, it’s because the world has been remarkably successful in shifting from a situation of food scarcity to abundance.

With food prices at their highest levels since at least 1990 and Indonesia embargoing exports of palm oil to cool the cost of cooking fats, shortages of nutrition may seem the more pressing problem. Still, obesity isn’t so much the enemy of hunger as its sibling — another symptom of a world unable to provide its people with the nutrition they need to lead a healthy life. In the years ahead, that threat will only grow – Bloomberg

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